Obesity among children between the ages of five and 19 years has increased ten times over the past four decades across the world, a new global study has found. If current trends continue, there will be more obese than underweight children by 2022, said the study that spans the years between 1975 and 2016.

Yet, India is one of the few regions in the world with a high number of undernourished children. It had 97 million moderately to severely underweight children in 2016, according to the study. In this category, it reports the highest numbers anywhere in the world.

While the incidence of underweight children is below 1% in 29 countries, it was high in south Asia and the highest in India. One in five girls (22.7%) and one in three boys (30.7%) in India was moderately to severely underweight in 2016, said the report.

Other countries with large populations of undernourished children are Niger, Senegal, Bangladesh, Myanmar and Cambodia–nations that are economically weaker than India.

The study, published in the medical journal Lancet, was led by Imperial College, London, and the World Health Organization (WHO). It analysed the body mass index (BMI) of more than 130 million children over the age of five years.

India has fallen three places in the Global Hunger Index and is now ranked 100th among 119 countries, IndiaSpend reported on October 12, 2017. India also has one of the highest incidences of wasting (21%) in children, the index said.

In India, only 1 in 10 children is well-nourished

At 48.2 million–nearly the population of Colombia–India has the highest number of stunted children in the world, IndiaSpendreported in June 2017. Only one in 10 children gets adequate nutrition, we reported in May 2017.

“India does not lack in effective policy but in (its) implementation,” Rajesh Khanna, senior technical advisor, Save the Children, a nonprofit, told IndiaSpend. Government departments such as women and child development and health and family welfare that run the Integrated Child Development Scheme (ICDS) do not work in convergence and there is no political will to ensure that they do, he added.

“There is no monitoring of policies to find the reason why some aren’t working,” Khanna said.

The reach of the National Health Mission (NHM)–which works on maternal and child health and the ICDS–can be higher, Purnima Menon, a senior research fellow at the International Food Policy Research Institute, pointed out. “Even in the case of something like antenatal care, a great platform to integrate nutrition interventions, the coverage is not as high as it should be,” she told IndiaSpend.

Malnutrition can be tackled more effectively and faster if these programmes are implemented because addressing the socio-economic factors underlying the problem–gender norms, exclusion and poverty–would need more concerted efforts, Menon added.

6% girls, 8% boys were obese in 2016

In 1975, only 1% of the world’s children–5 million girls and 6 million boys–were obese. By 2016, this number rose to over 50 million girls and 74 million boys, the study reported. This marks 6% of girls and 8% of boys in the 5-19 years category.

This means that the number of obese children increased from 11 million in 1975 to 124 million in 2016. There were also 213 million overweight children in the world who fall below the obese category.

Obese, Underweight Children In India & The World

Globally

6% girls and 8% boys obese

8.4% girls and 12.4% boys moderately to severely underweight

India

Less than 2% girls and less than 1% boys obese

22.7% girls and 30.7% boys moderately to severely underweight

Obesity among children is increasing in India too fast–the number stood at 14.4 million in 2015. This puts it behind only after China (15.3 million), according to this 2017 study in the New England Journal of Medicine.

Obesity rates have plateaued in higher income countries and are soaring in low and middle income countries, said lead author Majid Ezzati of the Imperial School of Public Health in a statement for the WHO.

“These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities. The trend predicts a generation of children and adolescents growing up obese and at greater risk of diseases, like diabetes. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods,” said Ezzati.

Why the rapid transition from underweight to obese in India is dangerous

The prevalence of obesity in India was less than 2% in the 5-19 year age-group in 2016, the report said. However, Indian children gain weight as they grow and 8-14% Indian adolescents are obese, experts pointed out.

“This combination of undernutrition in early life with obesity later is particularly pernicious so far as the risk of developing non-communicable diseases during adulthood is concerned,” said Vivekanand Jha, executive director, The George Institute for Global Health India, a research institute, in a press statement. “Interventions should focus on improving maternal and early childhood nutrition and focussing on risk factors that might cause overweight or obesity in the teens.”

Among Indian adults, obesity is a clearly rising trend. In 2005, 12.6% of women and 9.3% of men in the 15-49 year age-group were overweight. By 2015, this grew to 20.7% and 18.6% respectively–an increase of 8.1 percentage points for women and 9.3 percentage points for men.

The transition from underweight to overweight and then obesity can be rapid, an unhealthy transition that could strain the country’s health system and its ability to deal with the situation, authors of the study said.

“More broadly, in an unhealthy nutritional transition, an increase in nutrient-poor, energy-dense foods can lead to stunted growth along with weight gain in children, adolescents, and adults, resulting in higher BMI and worse health outcomes throughout the lifecourse,” the study said.

Undernutrition and obesity must be looked at comprehensively in an integrated fashion to counter both of them, the authors have suggested.

(Yadavar is a principal correspondent with IndiaSpend.)

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